Electronic health records (EHR)-based childhood asthma prediction may be a valid, cost-effective, and scalable option for early detection of at-risk children for targeted preventive intervention, but this approach has not been adopted in clinical practice. The purpose of this pilot study was to evaluate the feasibility and acceptability of the Pediatric Asthma Risk Score (PARS) as an EHR-based passive digital marker (PDM) for childhood asthma prognosis in clinical practice. Feasibility was defined by the level of concordance between the PARS and a clinician's classification of a case study's risk of developing school-age asthma. Acceptability was based on clinicians' intentions to use the PARS and its usability as a PDM for childhood asthma prognosis. Blinded to the PARS risk classification, clinicians were asked to predict the case study's risk of school-age asthma based on their professional judgment as either low or high risk and rate their confidence in their prediction. Unblinded to the PARS risk classification, clinicians rated the acceptability of the PARS as a PDM. Logistic regression models were used to summarize and identify correlates of feasibility and acceptability measures. There was 74% (95% CI: 66-81%) concordance between the PARS and clinician prediction of our case study's risk of developing school-age asthma. Risk discordance (26%) was associated with low confidence in a clinician's professional judgment (adjusted odds ratio [aOR]: 4.78; 95% CI: 1.85, 12.34) and PARS (aOR: 4.48; 95% CI: 1.16, 17.33). Unblinded to the PARS risk classification, more than 80% of clinicians ranked their intentions to use the PARS and its usability as a PDM as 4+ on a 0-6 Likert scale. Our findings demonstrate preliminary feasibility and acceptability of the Pediatric Asthma Risk Score (PARS) as a passive digital marker for childhood asthma risk, supporting further evaluation in prospective real-world studies.
Brushing with fluoride-containing toothpaste without rinsing significantly increases salivary fluoride concentration. To compare the effects of rinsing versus non-rinsing after toothbrushing with 1500 ppm fluoride (ppmF) toothpaste on salivary fluoride concentration up to 90 min and fluoride intake in 6-year-old children. A crossover clinical trial was conducted in 18 healthy 6-year-old children. Children brushed their teeth with 1500 ppmF toothpaste (0.6 g) with rinsing (WR) or without rinsing (WOR) in a three-day washout period. Unstimulated saliva was collected at baseline and at 1, 5, 15, 30, 60, and 90 min after toothbrushing. Salivary fluoride concentration was measured using an ion-specific electrode. Fluoride intake was also determined. The geometric mean salivary fluoride concentration was significantly higher in WOR than in WR over time (p = 0.023). Pairwise comparisons at specific time points showed a significant difference at 1-min post-brushing (p < 0.001). Fluoride intake was significantly greater in WOR than in WR (0.216 ± 0.046 vs. 0.176 ± 0.056 mgF; p = 0.012). Toothbrushing with 1500 ppmF toothpaste without rinsing produced higher fluoride intake and total fluoride exposure (AUC) due to a large initial peak; however, salivary fluoride concentrations were comparable between rinsing methods from 5 min onward and remained caries-preventive for up to 90 min.
Globally accelerated efforts are underway to eliminate dog-mediated rabies, underscoring the importance of effective anti-rabies prophylaxis. This study aims to assess the antibody response and its long-term persistence following rabies vaccination, their determinants, and suggest the optimal timing for a booster dose. We performed a retrospective cohort study among 150 participants, at the preventive clinic of Government Medical College, Thiruvananthapuram. Anti-rabies antibody titer in serum samples was estimated with the Rapid Fluorescent Foci Inhibition Test. To estimate the optimal timing for booster doses, the receiver operating characteristic (ROC) curve was plotted. Protective antibody titers (0.5 IU/ml) were observed in 92.7% of participants, with a mean titer of 3.81 (3.31) IU/ml. ROC analysis identified 5 years as a cut-off for booster dose. Regression analysis indicated a shorter time duration since last vaccination (P = .003) and intramuscular route (P = .005) as predictors of high antibody titers. However, the achievement of protective antibody titer was comparable for intramuscular and intradermal schedules. Achievement of protective antibody titers is universal and long-lasting following anti-rabies vaccination, irrespective of the route of vaccination. Five years since the last dose could be used as an optimal cut-off for booster dose.
Alcohol is one of the most widely consumed substances worldwide. It is hypothesized that people who use alcohol have poor emotional regulation strategies, something shared by people who commit suicide. Therefore, the aim of this work is to study the mediational effect of coping strategies and distress tolerance in the relationship between excessive alcohol use and suicidal risk. A sample of 1014 participants (33.82% male, 66.17% female; M = 33.0, SD = 15.15) were assessed using a custom sociodemographic questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), the Coping with Stress Questionnaire (CSQ), Distress Tolerance Stress (DTS), and Suicide Risk (RS). Two mediation models were performed in which AUDIT scores were used as the independent variable, RS score as the dependent and sex as a covariate. In the first model the mediating variable was the CSQ scores and in the second the DTS scores. The relationship was mediated positively by Negative Auto-Focused, Appraisal and Absorption, and negatively by Social Support Seeking and Tolerance. Emotional regulation is a transdiagnostic strategy that can reduce not only alcohol consumption, but also suicidal risk. Given these results, there is a pressing need to develop preventive programs centered on adaptive emotion regulation strategies. Emotional regulation plays a key role in the relationship between excessive alcohol use and suicidal risk. El alcohol es una de las sustancias más consumidas en todo el mundo. Se hipotetiza que las personas que consumen alcohol tienen pobres estrategias de regulación emocional, algo que comparten las personas que se suicidan. Por ello, el objetivo de este trabajo es estudiar el efecto mediacional de las estrategias de afrontamiento y la tolerancia a la angustia en la relación entre el consumo excesivo de alcohol y el riesgo suicida. En una muestra de 1014 participantes (33,82% hombres, 66,17% mujeres; M = 33,0, DE = 15,15) se aplicó un cuestionario sociodemográfico personalizado, el Test de Identificación de Trastornos por Consumo de Alcohol (AUDIT), el Cuestionario de Afrontamiento del Estrés (CSQ), la escala de Tolerancia al Distrés (DTS) y el de Riesgo Suicida (RS). Se realizaron dos modelos de mediación en los que se utilizaron las puntuaciones del AUDIT como variable independiente, la puntuación del RS como dependiente y el sexo como covariable. En el primer modelo la variable mediadora fueron las puntuaciones CSQ y en el segundo las puntuaciones DTS. La relación fue mediada positivamente por Autoenfoque Negativo, Valoración y Absorción, y negativamente por Búsqueda de Apoyo Social y Tolerancia. La regulación emocional es una estrategia transdiagnóstica que puede reducir no sólo el consumo de alcohol, sino también el riesgo suicida. Dados estos resultados, existe una necesidad imperiosa de desarrollar programas preventivos centrados en estrategias adaptativas de regulación emocional. La regulación emocional juega un papel clave en la relación entre el consumo excesivo de alcohol y el riesgo suicida.
In Mexico, tobacco use represents one of the leading threats to public health, being associated with thousands of preventable deaths and diseases. Social factors, such as peer pressure, play a significant role in the initiation of tobacco use among young people, who seek acceptance and identity. Although intervention studies exist, few address peer pressure comprehensively and from a theoretical framework. Therefore, a psychoeducational intervention is proposed for university students, with the aim of assessing its acceptability and feasibility, as well as exploring changes in self-esteem, emotional dependence, and social skills. Its contribution lies in providing preliminary evidence for future large-scale clinical trials. The study was designed as a prospective, single-arm pilot. Nursing students from a faculty in Veracruz will participate, with a recruitment target of 30 students aged 18 years or older. The group intervention consists of four 50-min sessions, in addition to pre- and post-test evaluations, addressing peer pressure, self-esteem, social skills, and emotional dependence. Tobacco use among young people is a multifactorial problem in which peer pressure constitutes a central factor. The proposed psychoeducational intervention seeks to strengthen resistance, promote self-esteem, enhance social skills, and address emotional dependence. Its implementation entails practical challenges, including student participation, retention, logistical organization, and resource availability. This study will allow for the evaluation of the intervention's acceptability and feasibility, generating preliminary evidence for future trials. The findings will contribute to the design of evidence-based preventive strategies relevant to the university setting and adolescent public health. UMIN000059102.
Lipid abnormalities-particularly low-density lipoprotein cholesterol (LDL-c) and lipoprotein(a) [Lp(a)]-have been implicated in aortic stenosis (AS), yet translation into clinically actionable risk assessment remains underdeveloped, especially regarding sex-specific evaluation. This study aims to quantify sex-specific associations between a comprehensive lipid profile and the risks of AS and aortic regurgitation (AR), and to identify the most informative markers and marker combinations for improved risk assessment. In 365,771 UK Biobank participants (mean age 56.1±8.07 years; 55.74% female) free of baseline cardiovascular disease. Routine lipid traits underwent hierarchical clustering and were related to incident AS and AR using sex-stratified Cox models. Discordance analyses and time-dependent concordance index were employed to compare risk assessment performance of different markers. Hierarchical clustering revealed three clusters in both sexes-an apolipoprotein B (apoB)-containing cluster and an apolipoprotein A containing cluster-while Lp(a) occupied an independent branch. During a median follow-up of 13.8 years, there were 3118 incident AS and 1239 AR cases. Total cholesterol, apoB, LDL-c, non-high-density lipoprotein cholesterol in apoB-containing cluster and Lp(a) were each independently associated with higher AS risk in both sexes (all P < 0.01), with Lp(a) conferred additional sex-specific effect (P for interaction = 0.004). Discordance analyses showed that apoB outperformed LDL-c in association with AS. Addition of Lp(a) to ApoB or LDL-c improved AS risk prediction over either marker alone-especially in men. No lipid trait was associated with AR. ApoB may substitute for LDL-c as the primary particle-burden marker, whereas Lp(a) should be incorporated as an independent sex-specific risk enhancer in AS risk assessment. These results support sex-specific, multi-biomarker assessment to optimize AS risk stratification and future preventive strategies. In 365,771 UK Biobank participants followed for a median of 13.8 years, apoB and Lp(a) improved identification of incident aortic stenosis risk compared with LDL-C alone. Incorporating Lp(a) into models with apoB or LDL-c improves AS risk discrimination, especially in men. ApoB outperforms LDL-c for AS risk assessment in both men and women.Elevated Lp(a) significantly increases AS risk, with a stronger effect in men.
To examine the extent of polysubstance use in the general population of Croatia, determine trends in polysubstance use between 2011 and 2023, and identify distinct subgroups based on the patterns of polysubstance use and compare these subgroups across survey years. Four studies were conducted between 2011 and 2023 on nationally representative samples of Croatian residents aged 15 to 64, with a total of 19 730 respondents, through face-to-face surveys in private households. Last-year substance use (tobacco, alcohol, cannabis, ecstasy, amphetamines, cocaine, and LSD) was assessed using the Croatian translation of the European Model Questionnaire. Across all four survey years, alcohol (71.8%-83.3%), tobacco (39.4%-43.7%), and cannabis (5.1%-10.2%) were the most commonly used substances in the Croatian general population. Last-year abstinence showed a declining trend between 2011 and 2023, single-substance use remained stable, and polysubstance use increased over this period. Latent class analysis identified three distinct subgroups: alcohol-only use, alcohol and tobacco use, and polysubstance use. Alcohol and tobacco use and polysubstance use classes increased in size from 2011 to 2023, with the polysubstance use class increasing from 0.9% in 2011 to 2.8% in 2023, alongside higher probabilities of cocaine and ecstasy use over time. Polysubstance use is a growing public health concern in Croatia. The trends of co-use of alcohol and tobacco and stimulants use with polysubstance use patterns were rising. These trends emphasize the need for further research and the development of targeted prevention and intervention efforts, accounting for distinct effects of polysubstance use and cultural specificities of Croatian society.
People with severe mental illness (SMI) are at an increased risk of infection mortality compared to the general population. Little is known about how this risk might differ across infection types, and the potential impact of sociodemographic and clinical factors. We investigated associations between SMI and infection mortality in a population-based cohort, examining variation by infection type and potential moderating factors. This retrospective matched cohort study (January 1, 2000 to December 31, 2019) used national primary care data from the UK Clinical Practice Research Datalink linked with Office of National Statistics mortality data. Competing risks regression and cause-specific hazard models assessed risk of infection mortality in people with SMI versus non-SMI controls. We examined risk across different infection types and assessed the impact of sociodemographic and clinical factors. Our cohort comprised 84 494 people with SMI matched on age, gender, and GP practice with 84 494 non-SMI controls. Fully adjusted models showed that people with SMI were more likely to die from any infection compared to non-SMI controls (adjusted hazards ratio (aHR) = 1.58, 95% CI, 1.44-1.74). Infection-specific analyses revealed increased risk of death from respiratory (aHR = 1.69, 95% CI, 1.51-1.89), gastrointestinal (aHR = 2.01, 95% CI, 1.16-3.48), and renal/urinary (aHR = 1.70, 95% CI, 1.32-2.19) infections in the SMI group. People with SMI are at increased risk of infection mortality, especially from respiratory, gastrointestinal, and renal/urinary infections. We recommend prioritizing this group for preventative measures including influenza and pneumococcal vaccines.
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PurposeTo examine the relationship between fall-related mortality, disability-adjusted life years (DALY), healthcare expenditures, and research funding and determine whether fall prevention funding is proportional to fall-related public health impact.DesignCross-sectional.SettingUnited States.SampleNot applicable.MeasuresMortality rates (2018-2022) for leading causes of death were obtained from CDC WONDER. Disability-adjusted life-year (DALY) rates (2021) were obtained from the World Health Organization. Healthcare expenditures (2016) were obtained from the Institute for Health Metrics and Evaluation. Research funding data (2018-2022) were obtained from NIH ExPORTER and linked to causes of death using MeSH term searches.AnalysisLinear regression models were used with log-transformed research funding as the dependent variable and log-transformed mortality rates, DALY rates, and healthcare expenditures as predictors.ResultsFall mortality rate was 13.1 deaths per 100 000 individuals, fall-related DALY rate was 713.2 per 100 000, and fall-related healthcare expenditures were $106.6 billion. Falls ranked 12th in mortality, 8th in DALY, and 5th in healthcare costs but 20th in research funding, receiving $489 million over 5 years. Falls received significantly less funding than expected based on mortality rates (predicted $1.95 billion), DALY rates (predicted $3.27 billion) and healthcare expenditures (predicted $5.63 billion).ConclusionAlthough falls have a significant impact on older adults' health and mortality, fall research funding is disproportionately low. To reduce mortality and mitigate rising healthcare costs associated with falls, federal investment in fall prevention research should be a higher priority.
Peer bullying in physical education (PE) poses a significant threat to student psychosocial development. This study examines pre-service PE teachers' perceptions, empathy levels, and intervention tendencies towards physical, verbal, and relational bullying situations. Using a vignette-based mixed-methods design, data were collected between April and June 2025 from 105 final-year teacher candidates (N = 105; 67.6% male). Participants were recruited via convenience sampling from six state universities across Türkiye: Dicle, Bartın, Tokat Gaziosmanpaşa, Çanakkale Onsekiz Mart, İnönü, and Akdeniz. All candidates had completed or were enrolled in the 12-week teaching internship. Quantitative data were analysed using ANOVA and t-tests, while qualitative data underwent thematic analysis following Braun and Clarke's framework. Quantitative results indicated that candidates attributed high seriousness, felt strong empathy, and showed a high likelihood of intervention across all bullying types, with no significant differences regarding gender or prior training. However, qualitative findings revealed three primary themes: Behavioural Control, Emotional Support, and Inclusive/Relational Strategies. These themes highlighted that sensitivity often failed to translate into pedagogical action, as most candidates relied on superficial, authority-based warnings. The findings suggest that high emotional awareness does not guarantee pedagogical competence in conflict resolution. Anti-bullying training should be integrated into teacher education through applied case analyses and scenario-based pedagogical studies to bridge the gap between intention and practice.
Major lower-limb amputation often leads to wound complications that delay recovery and prosthetic use. Negative Pressure Wound Therapy (NPWT) has been suggested to improve outcomes, but evidence is inconsistent. The objective of this study is to compare NPWT with standard wound therapy in fresh amputation stumps. A systematic review and meta-analysis following PRISMA and Cochrane guidelines included randomised and controlled observational trials. Primary outcomes were wound complications, including surgical-site infections (SSI) and wound dehiscence. Secondary outcomes included re-amputation, healing, and resource use. Seventeen papers including over 6745 patients were analysed. NPWT significantly reduced total wound complications (RR 0.49, 95% CI 0.37-0.66) and SSIs (RR 0.50, 95% CI 0.27-0.90), including both superficial (RR 0.30, 95% CI 0.12-0.73) and deep infections (RR 0.26, 95% CI 0.11-0.63). The secondary amputation risk was lowered by one-third (RR 0.67, 95% CI 0.50-0.89). Wound dehiscence risk decreased (RR 0.53, 95% CI 0.30-0.94). Mortality, readmission, and hospital stay showed no significant differences between groups. Healing outcomes strongly favoured NPWT: mean time to ≥ 76% granulation was shortened by 25 days, while complete closure occurred nearly two weeks earlier. Kaplan-Meier reconstruction confirmed that NPWT accelerated wound maturation by 77% (HR 0.23, 95% CI 0.12-0.44). Economic evaluations, though limited, indicated fewer dressing changes, reduced outpatient visits, and overall cost savings. NPWT after major lower-limb amputation halves wound complications and infections, lowers re-amputation, and accelerates healing. Despite unchanged systemic outcomes, the local benefits are clinically significant, supporting its use in standard post-amputation care. Trial Registration: CRD420251088214.
The requirement for hospital admission to initiate clozapine presents a health-systems-related barrier to clozapine prescription and contributes to its underutilization in treatment-resistant schizophrenia (TRS). This study aimed to examine the clinicodemographic characteristics associated with treatment settings for clozapine initiation within a first-episode psychosis (FEP) cohort attending an early intervention in psychosis service. Secondary analysis of a retrospective cohort study of 1220 young people presenting with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 2011 - 2017. Ninety-one cases of TRS were identified and included in the analysis, with 70 commencing clozapine, of whom 67 had a commencement setting identified. Over half (n = 36, 53.7%) commenced clozapine in the community. When compared to the hospital initiation group, the community initiation group were less likely to have had a hospital admission at baseline (odds ratio (OR) 0.26, 95%CI, 0.09-0.87) or an involuntary admission during the 2 year episode of care with EPPIC (OR 0.25, 95%CI, 0.09-0.70). The community initiated group had presented with less severe delusion scores on short form Scale for Assessment of Positive Symptoms at baseline (mean 3.08 vs 3.94, P = .031). First generation migrants were less likely to initiate clozapine in the community (OR 0.29, 95%CI, 0.09-0.97). The community initiation group also had reduced odds of clozapine discontinuation until discharge from EPPIC (OR 0.22, 95%CI, 0.06-0.76). Community initiation provides an alternative route to clozapine treatment and may be associated with a reduced rate of clozapine discontinuation.
Randomised trials have suggested the benefit of potassium-competitive acid blockers (P-CABs) is superior to proton pump inhibitors (PPIs) for ulcer recurrence in high-risk aspirin users. However, real-world comparative effectiveness across diverse antithrombotic regimens remains poorly defined. We evaluated P-CABs versus PPIs for preventing upper gastrointestinal (GI) bleeding in patients with acute atherothrombotic disease and using antithrombotic therapy. This retrospective cohort study utilised hospital-based Common Data Model data (2018-2024). Patients with acute cardiovascular or cerebrovascular disease receiving antithrombotic therapy who initiated a PPI or P-CAB were included. Drug exposure was modelled as a time-varying variable to mitigate immortal-time bias. The primary outcome was upper GI bleeding, analysed via time-dependent Cox regression adjusted for age, sex, comorbidities, and concomitant medications. Among 2255 patients (PPI: 1726; P-CAB: 529) in which 53 upper GI bleeding events occurred during a median follow-up of 637 days. P-CAB use was associated with a significantly lower risk of upper GI bleeding than PPIs (incidence rate 5.7 vs. 25.8 per 1000 person-year; adjusted hazard ratio [HR] 0.22, 95% CI 0.06-0.75, p = 0.016). P-CABs showed a profound reduction in moderate-to-severe upper GI bleeding (HR 0.11, 95% CI 0.02-0.60; p = 0.011). Notably, no bleeding events occurred in P-CAB users with high antithrombotic burden (≥ 2 agents). In patients receiving antithrombotic therapy, P-CABs are associated with a significantly lower risk of clinically significant GI bleeding compared to PPIs. These findings support P-CABs as a potent acid-suppressive strategy for gastroprotection in high-risk populations.
PurposeTo examine the relationship between political county-level partisanship and COVID-19 and flu vaccination uptake in the United States following the 2020 and 2024 presidential elections.DesignEcological, cross-sectional analysis utilizing public datasets.SettingAll 3224 US counties and county equivalents.SampleData includes 3224 counties; 3192 had complete COVID-19 vaccination data, and 3125 had complete flu vaccination data.MeasuresDependent variables were county-level flu and full COVID-19 vaccination rates. Independent variables included 2020 and 2024 GOP vote share, median household income, education, healthcare access, and county-level health indicators.AnalysisSpearman correlation, independent t-tests, and multivariate linear regressions.ResultsGOP vote share is strongly negatively correlated with COVID-19 vaccination (r = -.699, P < .001) and moderately with flu vaccination (r = -.427, P < .001). Counties in the highest GOP quartile had significantly lower vaccination rates than Democratic quartile counties (COVID-19: 45% vs 60%, t = -39.64, P < .001; flu: 35% vs 46%, t = -23.10, P < .001). Each percentage-point increase in GOP vote share is associated with a 0.45% decrease in COVID-19 uptake in 2024 (β = -.449, P < .001) and a 0.13% decrease in flu uptake (β = -.128, P < .001), independent of socioeconomic controls.ConclusionsPartisan alignment has become a significant determinant of vaccination, with the divide persisting between 2020 and 2024. Findings underscore the need for localized, depoliticized public health strategies.
Childhood trauma exerts lasting negative effects on mental health, with hard-of-hearing adolescents particularly vulnerable compared to their hearing peers. Yet we still know little about the relationship between childhood trauma, non-suicidal self-injury (NSSI) and depressive symptoms in this population, especially at symptoms level. In this study, a total of 2,008 Chinese students (hearing = 1,386; hard-of-hearing = 622) completed self-report questionnaires assessing childhood trauma, depressive symptoms and NSSI. Mediation analysis tested the indirect effect of depressive symptoms. Network analysis identified central and bridge symptoms, and directed acyclic graphs (DAGs) were used to explore potential directional pathways between symptoms. Depressive symptoms mediated the trauma-NSSI association, with a stronger effect among hard-of-hearing adolescents; For hearing adolescents, emotional abuse- and neglect-related items were central symptoms in trauma-depressive-NSSI network, whereas only an emotional neglect-related item was central for hard-of-hearing adolescents; DAGs further supported a pathway from trauma to depression to NSSI, pinpointing key symptoms driving this progression. Overall, this study underscores that trauma-depression-NSSI pathways vary across population at both construct and symptom levels, highlighting the importance of early identification and interventions targeting depressive symptoms to help prevent and relieve NSSI risk in trauma-exposed adolescents.
Phortica okadai (Diptera: Steganinae) is the primary vector of the zoonotic eyeworm Thelazia callipaeda (Nematoda: Spirurida). However, standardized laboratory rearing protocols for this vector are still lacking, which limits research on its biology and vector competence. We evaluated the effects of five diets (fermented apple, pear, banana, and two artificial diets) on life history traits of P. okadai using age stage, two sex life table analysis under controlled conditions (28 ± 1 °C, 75 ± 5% RH, 14:10 h L:D). Life table parameters and population dynamics were analyzed with TWOSEX-MSChart and TIMING-MSChart (100,000 bootstrap replicates). All tested diets supported complete development. Fermented pear yielded the shortest pre adult duration (17.34 days), the highest fecundity (116.6 eggs per female), and the greatest intrinsic rate of increase (r = 0.0902/day). Population projection showed that 10 initial eggs on fermented pear produced more than 1,200 adults within 90 days, which was approximately 10 fold higher than on other diets. Fermented pear is the most suitable substrate for establishing laboratory colonies of P. okadai. These findings facilitate vector competence studies and indicate that pear orchards are potential high risk habitats for T. callipaeda transmission, supporting targeted One Health surveillance and control.
This study examined the effect of early-life maltreatment on adolescent psychopathology and whether the significance and magnitude of this effect varied based on the presence of contamination (i.e., when individuals in a comparison group are exposed to maltreatment). Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1,354), a prospective cohort of children at risk for maltreatment. Children in the study were recruited by the time they were 4 years old (Mage = 4.56 years, SD = 0.70), and the sample was 50.8% female and 51.8% Black (25.7% White, 8.0% Hispanic, 1.0% Native American, 0.5% Asian, 11.3% mixed race, 1.7% other). Confirmed indicators characterized maltreatment prior to and after age 4 years. Adolescent self-report indicators identified maltreatment prior to 16 years of age and corrected contamination. Psychopathology was assessed via self-report at the LONGSCAN Age 16 assessment. Propensity score analyses indicated that maltreatment prior to 4 years of age only predicted significantly greater adolescent psychopathology symptoms after correcting contamination, B = 6.40, 95% CI [2.02, 10.79], SMD = 0.32, p = .004. Further, effect magnitudes increased 67% by correcting contamination. The results were robust to adjustments for maltreatment reexposure and covariate quality informing propensity score analyses. Correcting contamination can aid the discovery and replication of the effects of early life maltreatment on psychopathology.
To examine staff perceptions of a proactive, telephonic transition-of-care pilot model that connects pregnant people with recent emergency department (ED) utilization to early pregnancy-related care (e.g., prenatal care, abortion care, miscarriage support) and community resources. Although pregnant individuals disproportionately seek care in the ED, post-ED discharge models for care navigation remain understudied. Between August 2021 and June 2023, six sites (three health systems, two federally qualified health centers, and one community-based organization) implemented the transition-of-care model with ongoing support from an external organization ('external facilitator'). We conducted a qualitative descriptive study to explore pilot-engaged staff and leader perspectives regarding intervention fit and contextual factors influencing implementation and sustainability. From February to March 2024, we conducted interviews with 13 individuals (six outreach champions; four administrative champions; three senior leaders) representing all six pilot sites. Guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we employed codebook thematic analysis to identify key themes regarding the extent to which intervention characteristics met patients' perceived needs and factors influencing pilot site implementation and sustainability. Pilot site champions and leaders described the transition-of-care model as acceptable and feasible. Key strengths included the pilot model's patient-centered design (e.g., timely, proactive outreach and individualized support), health information exchange (HIE)-driven ED data infrastructure, and role of the external facilitator. Receipt of coaching and training on sensitive, respectful communication in the early pregnancy period also facilitated program implementation. Adequate outreach staffing acted as a barrier and potential determinant of sustainability. Our findings provide preliminary evidence in support of an outreach model to promote initiation of early pregnancy-related care following ED utilization and offer a flexible blueprint for adaptation across clinical settings. Our work meaningfully contributes to the limited literature base on early pregnancy care innovation.
The COVID-19 pandemic caused 10.5 million children and adolescents worldwide to lose a caregiver, with South Africa facing this crisis alongside the world's largest HIV epidemic. This study examines how overlapping crises shape HIV-related risk behaviours and mental health among affected young people. Using longitudinal data from 389 participants aged 9-18; researchers assessed HIV risk behaviours, mental health symptoms and social risks at two time points. Half the sample (50.4%) experienced COVID-19-associated orphanhood. Overall, HIV risk behaviours were common, reported by 78.9% at baseline and 73.5% at follow-up. However, reductions occurred only among non-orphaned children; those experiencing COVID-19 orphanhood showed a slight increase in risk behaviours over time. Orphanhood, older age, bullying, domestic violence and community violence were associated with higher HIV risk, while female sex and larger households were protective. Mental health symptoms were significantly worse among children living in HIV-affected households who also experienced COVID-19 orphanhood (66.7% at baseline), a pattern that persisted at follow-up. These findings highlight the heightened vulnerability of children facing multiple, overlapping crises. Effective HIV prevention and support strategies must account for the compounded impacts of pandemic-related loss, violence and pre-existing HIV burdens to protect long-term wellbeing.